Why Gender Matters p.270

A popular notion about transgender individuals is that sex-reassignment surgery reliably relieves the mental distress associated with being transgender. But researchers who have actually studied transgender individuals postsurgery have arrived at a different conclusion. As one investigator found, “even once the transsexual has achieved sex reassignment, the figure of being trapped in the wrong body, or being wrongly encased, continues to be evoked.”

Transgender adults who begin receiving hormonal therapy do benefit, on average, from that therapy: one year after starting hormonal therapy to transition to the desired gender, the rates of anxiety, depression, and impairment among transgender individuals are significantly reduced. Nevertheless, even after sex-reassignment surgery and hormone treatment, the rate of mental illness such as anxiety, depression, and bipolar disorder among transgender individual remains much higher than among the general population. “Sex reassignment is associated with more serious psychological sequelae and more prevalent regret than had previously been supposed,” conclude other reviewers. In the largest and longest follow-up available, researchers studied everybody who underwent sex-reassignment surgery in Sweden between 1973 and 2003: 191 MtF individual and 131 FtM individuals. These investigators found that 19 percent of MtF clients and 17 percent of FtM clients had been hospitalized for psychiatric problems prior to undergoing sex reassignment, compare with less than 4 percent of matched controls. After sex-reassignment surgery, transsexual clients were still nearly three times more likely than controls to be hospitalized for psychiatric problems other than gender dysphoria, even after adjustment for prior psychiatric problems. There was some benefit from sex-reassignment surgery, to be sure. Transsexuals who had undergone sex-reassignment surgery reported feeling less gender dysphoria – less of a sense of being trapped in the wrong body – and were somewhat less likely to be hospitalized for psychiatric problems than they were before the surgery.

But only somewhat. Even after sex-reassignment surgery, transsexual clients were still nearly five times more likely to have made a suicide attempt and nineteen times more likely to have died from suicide than were matched controls, again after adjusting for prior psychiatric problems. The researchers did not find any significant differences between MtF individual and FtM individuals on any of these outcomes. Being transgender, even in Sweden and even after having sex-reassignment surgery, puts you at much greater risk of having major psychiatric problems, including death by suicide. This finding is consistent with multiple other studies.

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